APPLICATION FOR A GUYANA PASSPORT

Republic of Guyana

APPLICATION FOR A GUYANA PASSPORT FORM A

Surname:

Maiden Name:

First Name:

Second Name:

Third Name (if any):

FOR OFFICIAL USE ONLY

Passport No.: __________________________ Date of issue: _______________________

Indicate whether applicant is: Under 16 years 16 and above

IMPORTANT: READ INSTRUCTIONS CAREFULLY BEFORE COMPLETING THIS FORM

INSTRUCTIONS ON HOW TO COMPLETE FORM

(A) Males (married or single) and women who have been

married (16 years of age or over). Complete Sections 1,

2, 6 and 7 if appropriate to their own applications.

(B) Married women of any age (including widows and

women whose marriage haven’t been terminated) are

required to complete Sections 1, 2, 3, 6 and 7 and if

appropriate to their own applications, section 4.

In cases where either parent is not available an Affidavit

from a Justice of Peace or Commissioner of Oaths is

required. The affidavit must indicate that the

child/children is/are in the custody of either parent

making the representation to apply and uplift the

passport for the child/children, or that the applicant is the

guardian of the child.

(D) Signing the form.

Section 7 should be completed by the person (the

recommender) verifying the declaration and who must

be a Member of Parliament, Mayor of City/Town,

Regional/ Village Chairman, Attorney-at-Law,

Permanent Secretary, Senior Officers of the Joint

Services ( below the rank of

S u p e r i n t e n d e n t / L i e u t e n a n t ) or

Headmaster/Headmistress/Principal of Schools,

Lecturers at Tertiary Institutions, Doctors, Justices of the

Peace and Commissioners of Oaths and Affidavits,

Business Managers or any person of similar standing

personally acquainted with the applicant.

When a previous marriage has been dissolved, the

applicant would be required to produce the final decree

of divorce or annulment.

The recommender must be a citizen of the Republic of

Guyana who would have known the applicant for two

(2) years or more, but must not be a member of the

applicant’s immediate family including mother, father,

husband, wife, uncle, aunt, son, daughter, etc.

DOCUMENTS TO BE PRODUCED

All documents must be produced in duplicate (certified

copy or original and photocopy)

(E) (i) Males (married or single) and women who

have not been married should produce birth

certificates or certificates of naturalization or

registration and identification cards as a citizen of

Guyana as the case may require.

(ii) Married women (including widows and women

whose marriage have been terminated) applying for a

passport should produce documents specified in (i)

above, together with marriage certificate.

(iii) NOTE: Where an Order has been made by the

High Court or in Chambers or by a Magistrate

regarding the custody of a child, such Order must be

produced and the nature of the Order stated.

(iv) Change of Name. If the applicant has changed

his or her name by Deed Poll and has registered the

change the Deed Poll must also be submitted along

with a recent Birth Certificate (within 6 months) as

evidence that a change of name has been effected.

(v) Persons born outside the Republic of Guyana

as constituted on 3

November, 1978 and all persons

claiming Citizenship by descent, naturalization or

registration , must complete Section 4B and produce

documentary evidence in support of the statement

made there in. e.g. birth certificate of descent

(Father/mother), naturalization or registration

document, or other evidence of citizenship.

PHOTOGRAPHS

The colour photograph of the applicant will be taken

at the booth at the Central Immigration and Passport

Office by a Data Entry Immigration Clerk. You must

submit a photograph which must confirm to the

following specifications.

P h o t o g r a p h s m u s t n o t b e l a r g e r t h a n

45 x 35mm (1.77 x 1.38 in) nor smaller than 32 x

26mm (1.26 x 1.02 in). Portraits taken with a digital

camera should be at high quality and resolution and

be printed on photo quality paper.

The recommender is also required to endorse and

stamp the reverse side of the copy of the photographs

with the words:

“I certify that this is a true likeness of Mr., Mrs. or

Miss…………………………………………...” and

add his or her signature.

FORM A

For official use only

Applicant’s Signature (Do not exceed rectangle)

For official use only

GENERAL INFORMATION

Surname (state whether Mr., Mrs., Miss(Sn., Fr., Rev or Dr.):

Marital status: Single Married

Divorced Widowed

First names

Personal Description

Gender: Male Female

Height: cm

Colour of eyes:

Hair Colour:

Special, peculiar (visible) marks:

Maiden Surname: (if applicant is woman who is or has been married)

Has name been changed otherwise than by marriage? No Yes

If so , state original name:

Name Change Document

Age at last birthday:

Date of birth (day/mm/yr)

Country of Birth:

Place of Birth:

Profession or occupation:

Present address:

Usual place of residence:

Local telephone no.:

fax no.:

e-mail:

Citizenship

State whether Citizenship of the Republic of Guyana by : Birth Naturalization Decent Adoption Registration

If Citizen of the Republic of Guyana by any of the above, give particulars of supporting document.

Document Number: Place of Issue: Date of Issue:

Married women applying for a passport must complete this section.

Husband’s or former husband’s surname and full First names:

Place of marriage:

Date of marriage (day/mm/yr)

PERSONS BORN IN (A) ANY BRITISH COMMONWEALTH COUNTRY OR IN SOUTHERN IRELAND, IN A BRITISH PROTECTORATE,

PROTECTED STATE OR MANDATE OR TRUST OR (B) IN ANY FOREIGN COUNTY MUST COMPLETE A OR B BELOW:

If applicant’s birth was registered as a citizen of the Republic of Guyana abroad, state:

Name of consulate

Date of registration

Place and date of father’s birth

B Paticulars of applicant father:

If born in Guyana If Citizen of Guyana by Naturalization or REGISTRATION

Place of birth

Date of birth

No. of Certificate

Date and place of Issue

To avoid delay, answers to all relevant sections should

be completed in ink.

Please fill out the form in BLOCK CAPITALS

Note: Do not sign form until you have read all the notes

on page 1

Photo

Passport Number

FORM A

To Chief Passport Officer

This is to certify that, I …………………………………………………………………. am the legal guardian of

Name in full

………………………………………………………………………………………………………….

I hereby authorize you to issue him/her with a passport of the Republic of Guyana.

Signature …………………………………………………………………………….

Relationship of applicant to child. Parent Guardian

USE OF PASSPORT

Passport required for travelling to: ………………………………………………………………………………..

Purpose of travel …………………………………………………………………………………………

DECLARATION

Please indicate by a tick in the box provided

A – I the undersigned, hereby apply for the issue of a passport.

B – I declare that the information given in this application is correct to the best of my knowledge and belief

C – That I have not lost the status of Citizen of the Republic of Guyana.

D – That I have not previously held or applied for a passport of any description.

E – That all previous passports granted to me have been surrendered, other than

travel Document No……………………………………which is now attached and that I have made no other application

for a passport since the attached passport or travel document was issued to me.

Signature……………………………………………………………………………….Date…………………….

REFERENCE: Applies to persons applying for a passport

Recommender: I……………………………………………………………………certify that the applicant has been known

Personally to me for......years and that to the best of my knowledge and belief, the facts stated on this form are true and correct.

Signature…………………………………………………………………………….Date………………………

Rank or Profession……………………………………………………………………………

Address…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………...

......................................................................................................................................................

Office Stamp (if any)

IMPORTANT: Applicant and recommender are warned that should any statement contained in their respective declarations

prove to be untrue, the consequences to them may be serious. The attention of persons who are asked to sign this declaration is

specially called to the fact that it should be signed from personal knowledge of the applicant and not from information obtained

from persons, and that they should know the applicant for at least two (2) years.

FORM A

Lost or Stolen Passport Information Sheet

Surname:

First Name (s):

Gender Male Female

Passport number

Date of birth

Date of issue

Place of birth

Document (Registration) No.

Document Type

Was police notified

Date loss

Date of recovery

Date of police notification

Police Report No.

Place of loss

Place of issue

Recovery measures

Remarks/Observations

I hereby certify that the above particulars are correct and undertake that in the event of the passport coming again into my

possession it will be handed over to the Passport Office or the nearest Police Station in Guyana or Guyana Consulate

Overseas.

Signed: ………………………………………………………………………………Date:…………………………………

FOR OFFICIAL USE ONLY

DOCUMENTS PRODUCED TO BE NOTED HERE

Applicant’s birth certificate

Marriage certificate